Association Between the Mitral Annular E/e' Ratio and In-Hospital Mortality in Acute ST-Elevation Myocardial
Ashish K Jain1, Ajay Sharma2, Raghvendra S Meena2
1Department of Cardiology, All India Institute of Medical Sciences, Bhopal, IND.
Insights
Early measurement of the mitral annular E/e
Area of Science:
- Cardiology
- Echocardiography
- Acute Myocardial Infarction
Background:
- Left ventricular (LV) diastolic dysfunction and elevated LV filling pressures are linked to poor outcomes in acute ST-elevation myocardial infarction (STEMI).
- The mitral annular E/e' ratio, derived from tissue Doppler imaging, estimates LV filling pressure noninvasively.
- The prognostic significance of early E/e' ratio measurement post-STEMI admission is not well-established.
Purpose of the Study:
- To assess the association between the early mitral annular E/e' ratio and in-hospital mortality in patients with acute STEMI.
Main Methods:
- Prospective observational study of 256 consecutive STEMI patients.
- Transthoracic echocardiography with tissue Doppler imaging performed within 24 hours of admission.
- Measurement of mitral inflow velocities (E, A), mitral annular early diastolic velocity (e'), and calculation of the E/e' ratio.
Main Results:
- 30% of patients (n=77) had an elevated E/e' ratio (>15), indicating increased LV filling pressures.
- In-hospital mortality was significantly higher in patients with E/e' >15 (34%) versus E/e' ≤15 (4%) (p=0.002).
- Elevated E/e' was independently associated with in-hospital mortality, alongside Killip class ≥II.
Conclusions:
- An elevated mitral annular E/e' ratio measured early after STEMI admission is a strong, independent predictor of in-hospital mortality.
- The E/e' ratio provides valuable prognostic information, complementing the Killip class.
- Early E/e' measurement can enhance bedside risk stratification for STEMI patients.
Abstract:
Background Left ventricular (LV) diastolic dysfunction and elevated LV filling pressures are associated with adverse outcomes after acute ST-elevation myocardial infarction (STEMI). The tissue Doppler-derived mitral annular E/e' ratio provides a simple, noninvasive estimate of LV filling pressure; however, its prognostic value when measured early after admission remains unclear. This study evaluated the association between early mitral annular E/e' ratio and in-hospital mortality in patients with acute STEMI. Materials and methods In this prospective observational study, 256 consecutive patients admitted with acute STEMI underwent transthoracic echocardiography with tissue Doppler imaging within 24 hours of admission. Mitral inflow velocities (E, A), mitral annular early diastolic velocity (e'), and E/e' ratio were measured. Patients were followed until hospital discharge. The primary endpoint of the study was all-cause in-hospital mortality. Results Seventy-seven patients (30%) had an elevated E/e' ratio (>15), suggestive of increased LV filling pressures. In-hospital mortality was significantly higher in patients with E/e' >15 compared with those with E/e' ≤15 (34% vs. 4%, p = 0.002). Elevated E/e' was also associated with reduced LV ejection fraction and abbreviated deceleration time. After multivariable analysis, E/e' >15 and Killip class ≥II at admission were independently associated with in-hospital mortality. Conclusions An elevated mitral annular E/e' ratio measured within 24 hours of admission is strongly and independently associated with in-hospital mortality in acute STEMI. Together with the Killip class, E/e' offers complementary prognostic information and may enhance early bedside risk stratification.
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